Foundation for HealthSmart Consumers: New OTC reimbursement rule will be costly

By Michael Johnsen

WASHINGTON A panel of healthcare thought leaders has concluded that a recent IRS rule change requiring a written prescription so that over-the-counter medicines can be eligible for reimbursement under flexible spending accounts will demand retail system challenges that are operationally impossible to overcome in the time frame required.

“We see this as a threat to consumer access and choice at a time when we need our citizens to be more engaged in managing their health and the cost of care,” stated Jon Comola, executive director of the Foundation for HealthSmart Consumers. Because of the new rule change, Comola said, “some consumers are likely to seek prescriptions for OTCs or alternative [prescription] drugs in order to comply with the new tax requirement.”

According to Foundation researchers, the resulting costs could reach $2.5 billion annually if office visits and lab tests are incurred by even 10% of the insured population; potential new pharmacy costs could reach $3 billion annually.

“We are concerned about the negative impact on people who are using OTCs to address health issues like smoking cessation, weight control, arthritis and allergies because of the increased tax on higher cost products,” said Jim Parker, fellow for The Foundation. “This may result in increased physician visits and potentially the prescribing of more expensive prescription drugs.”

The number of consumers who take advantage of health spending accounts is not insignificant, the Foundation added. “More than 50 million of the 195 million commercially insured consumers have healthcare accounts and will be directly affected by this new rule,” noted Roy Ramthun, president HSA Consulting.

As of Jan. 1, consumers will no longer be able to pay for most OTC medicines with funds from their flexible spending accounts and other health accounts (including HSAs and HRAs) unless the OTCs are “prescribed.” Retailers already are taking steps to warn shoppers of the new restrictions on purchases of OTC medicines using funds from their healthcare accounts.

This rule change, enacted as part of the Patient Protection and Affordable Care Act, is intended to help fund increases in healthcare spending in other parts of the bill.